Compliance to ADHD treatment in children and adolescents is high, but declines over time

Home | Compliance to ADHD treatment in children and adolescents is high, but declines over time

30 Jun 2015

Wehmeier PM et al. Atten Def Hyp Disord 2015; 7: 165-174.

Treatment compliance in children and adolescents with ADHD declines over time, with comparable adherence rates in patients on atomoxetine and psychostimulants, reports a recent German study.

Clinicians participating in this prospective, observational open-label study enrolled 504 treatment-naïve children and adolescents (aged 6–17 years) with ADHD. Data were collected at baseline and at regular intervals up to 12 months, at which point patients exited the study. Medication adherence was measured using the Pediatric Compliance Self-Rating (PCSR) scoring instrument and the Medication Adherence Rating Scale (MARS), which was used to obtain ratings of adherence from the child, their parents and clinicians.

After 12 months, 364 patients (72.2%) had completed the study. At baseline, 252 patients (50.0%) were being treated with atomoxetine, of whom 123 (48.8%) were still receiving atomoxetine monotherapy at Month 12 (n=31 had switched to psychostimulant; n=11 received both drugs; n=10 received no drug). Of the 247 patients (49.0%) being treated with psychostimulants at baseline, at Month 12, 176 (71.3%) were still receiving psychostimulant monotherapy (n=9 had switched to atomoxetine; n=4 received both drugs; n=4 received no drug). The majority of patients who completed the study met PCSR medication adherence criteria ([PCSR score ≥5] atomoxetine: 67.5%; psychostimulant: 74.2%). However, child-, parent- and clinician-reported MARS scores declined from baseline to last observed value for both atomoxetine- and psychostimulant-treated patients, indicating that medication adherence decreased over the study period, with no significant PCSR differences overall between medication groups (p=0.501). None of the 41 covariates assessed in the logistic regression analysis were identified as predictors of adherence.

This study is limited in that it does not reflect prescribing patterns in practice; patients on atomoxetine were over-represented in this study. Furthermore, there was no placebo control group for comparison purposes. However, the authors conclude that their study provides observational data on medication adherence in children and adolescents with ADHD complementary to that of randomised controlled trials.